home Thyroid Sarcoidosis of the intrathoracic lymph nodes is dangerous. How dangerous is this mysterious disease? deep sarcoidosis

Sarcoidosis of the intrathoracic lymph nodes is dangerous. How dangerous is this mysterious disease? deep sarcoidosis

According to information provided by WHO, pulmonary sarcoidosis is on the list of respiratory diseases that are most dangerous to human health. What it is is a question that interests not only sick people.

Considering the asymptomatic nature of the disease early stages development, understanding the mechanism of its occurrence makes it possible to timely detect an impending threat and take measures to eliminate it.

Pulmonary sarcoidosis - what is it?

Pulmonary sarcoidosis is a systemic pathology of the respiratory system, the development of which is accompanied by damage to lung tissue with the formation of granulomas - small, limited in size inflammatory areas in the form of dense nodules. The disease is classified as benign granulomatosis.

As sarcoidosis develops, the intrathoracic, tracheobronchial and bronchopulmonary lymph nodes are affected, and the number of granulomas increases many times over. Gradually, the granulomas merge, forming large areas of damage, within which the natural functionality of the organs becomes impossible.

Resorption of granulomas and the occurrence of fibrous changes are a typical outcome of the development of sarcoid nodules.

Pathology does not have infectious nature and is not dangerous to people around the patient. Most often, it occurs in women in young and middle age.

Despite the huge number of versions of the origin of sarcoidosis, none of the etiological theories has received factual confirmation. Moreover, it still remains a mystery to scientists why non-smoking patients are more susceptible to sarcoidosis.

Causes of the disease

Since accurate data on the causes of the development of sarcoidosis of the lungs and intrathoracic lymph nodes science does not yet have it, doctors are inclined to believe that the occurrence of a disease is the result of exposure to pathogenic factors environment and genetic predisposition.

Hypothetically, the most likely causes of sarcoidosis are:

infectious lesion - viruses of the herpetic group, fungi, bacteria and other types pathogenic microorganisms;
a type of allergic reaction to chemical and biological irritants;
lack of an adequate immunological response of the body to pathogenic agents.

According to one of the versions considered by the world scientific community, sarcoid granuloma is a clinical and morphological phenomenon that develops against the background of the influence of pathogenic agents on an immune-weakened organism. In this case, influencing factors can be of both exogenous (external) and endogenous (internal) nature.

Thus, low level cellular immunity- one of the characteristic prerequisites for the occurrence of sarcoidosis.

Pulmonary sarcoidosis: what is it? Pulmonary sarcoidosis, or Beck's sarcoidosis, is one of the diseases related to systemic benign granulomatosis that affects the lymphatic and mesenchymal tissue of various internal human organs, mainly the respiratory organs.

Development of such pathological process characterized by the appearance of epithelial granulomas in the affected inflammatory process organs, including the lungs. Granulomas are a kind of inflammation of the tissues of an internal organ and have the appearance of nodular neoplasms. Such neoplasms after a certain period of time can merge with each other and have a multiple character. The formation of foci of sarcoidosis granulomas in a particular organ causes various disturbances in its functioning, as a result of which a person develops characteristic manifestations of the development of sarcoidosis.

This disease mainly affects people of young and middle age, that is, from 20 to 40 years. At the same time, pulmonary sarcoidosis is most often diagnosed in the fair sex. The final stage of development of Beck's sarcoidosis is characterized by either complete resorption of nodular neoplasms in the lungs or the formation of fibrous changes in the tissues of this internal organ.

Causes of the disease and its mechanism of development

The nature of the occurrence of such a pathological process as Beck's sarcoidosis has not been fully established to date. However, there are many assumptions about the etiology of this disease. For example, there is an infectious theory of the origin of pulmonary sarcoidosis, which states that this kind of disease can occur in a person due to the development in his body of any pathogenic microorganisms (fungi, mycobacteria, histoplasma and spirochetes).

In addition, there is an assumption that this disease may have a genetic etiology, that is, be hereditary. This assumption was made as a result of observations in medical practice affecting members of the entire family with pulmonary sarcoidosis.

Some experts argue that Beck's sarcoidosis occurs in a person against the background of the presence in his body of any autoimmune disorders that can form as a result of exposure to both endogenous ( autoimmune pathologies, arising as a result of the pathological production of autoimmune antibodies, or killer cells, which negatively affect healthy tissues of their own body), and exogenous (various chemical substances, viruses, bacteria and dust) factors.

The development of pulmonary sarcoidosis in most cases is diagnosed in people working at any chemical enterprises, agricultural workers, sailors, mechanics, millers, employees in any health care institutions and firefighters. In addition, people who abuse tobacco smoking are at risk for the occurrence of such a pathological process. These people are most at risk of developing pulmonary sarcoidosis, since their body is constantly exposed to various toxic substances and pathogenic microorganisms.

A disease such as Beck's sarcodiasis has a multiorgan course, the development of which occurs with the occurrence of an inflammatory process in the alveolar tissue of the lungs, which, in turn, is accompanied by the formation of extensive damage to the interstitial lung tissue(alveolitis) and the occurrence of sarcoid tumors in the interlobar grooves, peribronchial and subpleural tissues. In case of further development of the pathological process, a person may experience serious disorders respiratory function lungs.

Stages of development of pathology and its forms

This disease can occur in several stages, the development of which will correspond to the following forms of the pathological process:

intrathoracic (lymphoglandular) form. This form of development of pulmonary sarcoidosis is considered initial and therefore is the primary stage of development of the inflammatory process during internal organ. The first stage of the disease is characterized by bilateral enlargement of the bronchopulmonary, bifurcation, paratracheal and tracheobronchial lymph nodes;
Sarcoidosis of the 2nd stage of development is characterized by the occurrence of bilateral focal infiltration (the formation of an accumulation of cellular elements not characteristic of the composition of the lung tissue), as well as damage to the intrathoracic lymph nodes. Stage 2 pulmonary sarcoidosis corresponds to the development of such a form of pathological process as mediastinal-pulmonary sorcaidosis;
pulmonary form of Beck's sarcoidosis. The development of this form of pulmonary disease is characterized by the occurrence of pneumosclerosis (replacement of normal lung tissue with connective tissue). In this case, an increase in the size of the intrathoracic lymph nodes is not observed. The pulmonary form of sarcoidosis is the third stage of development of the pathological process. As a result of the progression of pneumosclerosis, the patient may develop a disease such as emphysema - chronic illness lungs, characterized by irreversible and persistent expansion of the air cavities and excessive swelling of the lung tissue.

Pulmonary sarcoidosis can develop in three main phases:

active, that is, exacerbation of the pathological process;
stabilization;
regression of pathology. that is, its gradual attenuation.

Moreover, this disease can occur in both acute and chronic forms.

Signs accompanying the development of the disease

Pulmonary sarcoidosis symptoms can be very diverse and at the same time have a nonspecific nature. TO general manifestations inflammation of the lung tissue can be attributed to:

feeling of weakness and general malaise;
rapid fatigue even when performing minor physical activity;
feeling of inexplicable anxiety;
loss of appetite and, as a result, a sharp decrease in body weight;
fever (temporary increase in human body temperature);
various types of sleep disorders, characterized by a person’s inability to sleep normally at night;
increased sweating, occurring mainly at night.

The lymphoglandular form of the inflammatory process in the lung tissues may not be accompanied at all by the occurrence of any characteristic symptoms, while the other half of people with sarcoidosis may experience the following signs of the development of the pathological process:

the appearance of painful and uncomfortable sensations in the area chest;
feeling of constant weakness;
painful sensations in the joints, which are especially noticeable when moving;
the occurrence of shortness of breath which may be accompanied by a dry cough;
hoarseness in the lungs when inhaling air;
increase in body temperature;
in the case of a procedure such as percussion (examination of the lungs using a special technique of tapping the chest), an increase in the size of the pulmonary roots is detected on both the right and left sides;
the formation of inflammatory processes in the superficial vessels of the skin and subcutaneous fat. This phenomenon is called erythema nodosum.

The mediastinal-pulmonary course of sarcoidosis, or sarcoidosis of the second stage, is accompanied by the appearance of the following symptoms in the patient:

severe cough;
shortness of breath;
pain in the thoracic region;
hoarseness in the lungs, the presence of which can be detected through auscultation (the doctor listens to the sounds that arise in the chest while a person inhales air).

The third stage, that is, the pulmonary form of development of the pathology, is characterized by the occurrence in a sick person painful sensations in the sternum, shortness of breath, severe cough with sputum production. Besides, this stage the course of the inflammatory process in the tissues of the lungs is accompanied by the occurrence of arthralgic manifestations ( joint pain), cardiopulmonary failure, emphysema and pneumosclerosis.

Method of treating pulmonary pathology

Pulmonary sarcoidosis, the treatment of which lasts 6 to 8 months, is prescribed to a sick person only after dynamic observation behind general condition patient and the development of this disease. Providing emergency medical care carried out only in cases of acute and severe pulmonary disease and if the patient has lesions of the intrathoracic lymph nodes.

Inflammatory lung disease - sarcoidosis - is treated by prescribing the patient to take various anti-inflammatory and steroid drugs. medications. In addition, immunosuppressants and antioxidants are used in the treatment of this disease. The dosage and selection of medications is carried out only by the attending physician individually for each patient.

During hormonal course For the treatment of pulmonary sarcoidosis, the patient must use medications containing potassium and adhere to special dietary nutrition based on consumption large quantity protein and limited salt intake.

Medical registration of patients with sarcoidosis in the case of a favorable course of the pathology can generally last for 2-3 years, but in the case of severe Beck’s sarcoidosis this registration can last for 5 years.

A disease such as pulmonary sarcoidosis has a relatively benign course. However, if this kind of pathological process is not treated, then the sick person may experience all sorts of serious complications caused by the disease, which in some cases can cause death.

The initial forms of the disease include an increase in VLN in the absence of radiological signs of lung damage. However, in almost a third of cases, changes are detected in other organs. The disease is generalized. Most often, the external lymph nodes (cervical, axillary, inguinal and elbow) are enlarged, the skin is affected, and less often the eyes and other organs are affected.

The clinical manifestations of sarcoidosis at this stage are varied. In some, the disease proceeds without them, manifesting itself only by enlargement of the intrathoracic lymph nodes, which is detected during a preventive fluorographic examination; in others, it begins gradually, subacutely, and less often - acutely.

In acute manifestations of sarcoidosis (mainly in young women), there is a temperature, sometimes +38-39C 0, swelling of the joints, erythema nodosum, mainly on the skin of the lower extremities. Less common in sarcoidosis than in specified diseases(in 1/3 of patients), weakness, malaise, fever, dry cough, increased ESR are noted. Of these, 1/5 of the patients complain of shortness of breath, girdle pain in the chest, joints, and muscles of the torso. Quite rarely, weight loss and wheezing in the lungs are detected. However, in almost 60-70% of cases, tuberculin sensitivity decreases, up to negative Mantoux reactions, lymphopenia is observed, and in ¼ cases - monocytosis.

X-ray picture: characterized by an increase in the size of VGLU groups. As a rule, hyperplastic bronchopulmonary lymph nodes are identified in all, tracheobronchial in 40%, paratracheal in 30%, bifurcation in 10%. Usually these changes are bilateral, symmetrical.

For sarcoidosis VGLU not marked: a) unilateral hyperplasia of the mediastinal lymph nodes; c) isolated enlargement of the paratracheal lymph nodes, as happens with lymphogranulomatosis. Only in some patients is there a consistent involvement of bronchopulmonary and then other groups of lymph nodes in the process.

The latter are the same in size, most often large (4-6 cm in diameter) and medium (2-4 cm), less often small (less than 2 cm). They have an irregular spherical or oval shape, clear smooth contours, homogeneous structure without signs of perifocal infiltration. The outer border of the enlarged lymph nodes, facing the lung, forms a continuous polycyclic contour, and their varying depths are radiologically displayed as a “backstage” symptom.

Differential diagnosis:

VGLU sarcoidosis is differentiated from tuberculosis of the intrathoracic lymph nodes, lymphogranulomatosis, lung cancer, mediastinal tumor, pneumonia, and in 15% of cases the diagnosis of sarcoidosis is not established at all. The reasons for misdiagnosis are, on the one hand, the commonality of a number of clinical signs of sarcoidosis with the diseases listed above (weakness, general malaise, sweating, pain in muscles and joints, dry cough, shortness of breath), on the other hand, insufficient knowledge of the clinical symptoms of the disease.

Pulmonary sarcoidosis is a benign pathology characterized by the formation of inflammatory foci (granulomas) in the lung tissue, shaped like nodules. The disease belongs to the category of systemic, the negative can be felt by the entire body. However, more often, the lesion affects the lungs and lymph nodes.

There are no age or territorial restrictions; women and men are equally susceptible. Is it true female body an additional relapse is characteristic, at an interval between 40-60 years.

The peak occurs in the age range of 25-49 years. Respiratory system - intrathoracic lymph nodes (HTLU), lungs, “favorite target” for attacks of sarcoidosis. In addition, the list of organs capable of being attacked by granulomas will be supplemented:

As granulomatous accumulations grow, they merge, forming multiple inflammatory foci. Such sarcoid granulomas seriously harm the functionality of the organ in which they are located. The disease develops, negative symptoms occur, and fibrotic changes are likely in the affected area.

As you can see, the list is extensive, the systemic nature of the pathology is obvious, so therapy is prescribed and adjusted exclusively by a pulmonologist, who will competently assess the severity of the lesion and prescribe the correct, complete treatment.

What are the causes of the disease

The etiology has not yet been officially formulated. There is no reliable information confirming the nature of origin. There are hypotheses that the following risk factors give an impulse boost:

infectious
genetic
professional
domestic
medicinal

Let us dwell in more detail on each of the factors listed above.

Infectious hypothesis is based on the fact that some pathogenic microorganisms provoke the onset of the disease. The list of probable pathogens includes bacteria, viruses, fungal microorganisms:

Mycobacterium tuberculosis - tuberculosis occurs
Chlamydia pneumoniae - the causative agent of chlamydia
Helicobacter pylori - gastritis develops,
Viruses - hepatitis C, herpes, rubella, adenovirus infection
Mycoses
Spirochetes
Histoplasma capsulatum - provokes histoplasmosis

There are plenty of provocative bacterial microorganisms that influence the development of the disease, but it was not possible to identify a single infectious agent that is guaranteed to indicate the disease.

Genetic factor is still considered exclusively theoretical, since there is no specific data on changes at the gene level that affect the development of pathology.

Professional- there is a tendency for sarcoidosis to affect workers in the following professions:

The main risks are dust, polluted air, fertile ground for the development of pathology.

In addition, dust particles of metals are involved in the formation of foci of granulomatous accumulations:

beryllium
cobalt
aluminum
zirconium

Household causes that indirectly affect the course of the disease include mold, which penetrates inside along with the air.

Medication hypothesis The influence of certain drugs on the progression of the disease is based on data that long-term use of certain drugs increases the inflammatory process.

Pulmonary sarcoidosis is not a contagious pathology, there is no danger of contagion.

Classification of sarcoidosis

There are four characteristic stages:

Zero - there are no painful symptoms, x-rays do not reveal pathological disorders.
The first is that the lung tissue is not affected, but a slight change in the size of the intrathoracic lymph nodes is noted. The pulmonary lymph nodes, called bronchopulmonary, become inflamed and asymmetrically enlarged. Other intrathoracic lymph nodes- paratracheal, bifurcation, tracheobronchial, less likely to suffer from a pathological process.
Number two is called mediastinal - the attack spreads to the lymph nodes. Focal darkening of the lung tissue is classified into small, medium, large, when the size of granulomas is comparable to small tumors. The patient experiences difficulty breathing and noticeable painful sensations in the chest. The mediastinal form is “fixed” by fluorography, but the presence of sarcoidosis can be clearly established by a biopsy procedure - morphological confirmation of lymphoid cells.
Third, noticeable changes in the lung tissue are detected.
The fourth is fibrosis, an irreversible replacement process occurs connective tissue, with the formation of scars. Pathological disorders lead to increasing respiratory failure, and the likelihood of critical consequences for the body increases.

In addition to the stages described above, sarcoidosis is classified according to localization, nature of course, and rate of increase of pathological changes.

Localization:

intrathoracic lymph nodes
lungs
The lymph nodes
respiratory system
numerous lesions of organs and body systems

Character of the course

active, stabilization, decay phases

Slew rate

chronic
abortifacient
growing
slow

Clinical picture

The disease is prone to self-regression and has the ability to “disappear” without medication. Not every manifestation is accompanied by therapeutic intervention.

If the diagnosis is established, but no medical prescriptions are followed, then it is extremely important for the patient to adhere to the following recommendations for preventive purposes:

systematically monitor your work and rest schedule
exclude any
avoid stressful situations, reduce psychological stress
increase the share of vitamins in your daily diet

Three months after the initial diagnosis, a secondary ultrasound is performed, on the basis of which a verdict on further treatment is made.

As the disease develops, pathological changes in the lungs can go through three stages:

Stage one, initial - the formation of inflammatory granulomatous accumulations; accurate diagnosis is problematic.
Stage two - the formation of new foci of inflammation stops. Increasing the size of “old” formed granuloma slows down. Clinical symptoms remain, but the patient’s condition does not seriously deteriorate.
The third stage - the disease develops slowly, the accumulation of granulomatous cells increases. Foci of necrosis are formed, symptomatic picture is expanding due to pathological signs from other organs that were previously in good health.

There is a list of general nonspecific symptoms, the presence of which does not indicate a lesion, but the presence of such manifestations is the primary “bell” of approaching sarcoidosis.

To the number initial symptoms diseases include:

Persistent fatigue and weakness are the “leading most popular” complaints among nonspecific symptoms. A systematic state of weakness is an early warning sign of the body, the appearance of which is possible long before a visit to the doctor. Weakening can overwhelm the patient for a long time (months) until other pathological signs appear.
Weight loss is noted along with characteristic features, at the stage when the diagnosis is completed. The decrease in body weight is caused by: difficult-to-treat inflammatory phenomena that “rule” in the lungs, and metabolic disorders. The body is not able to fully absorb nutrients.
Fever is an “infrequent guest”, the temperature increase is moderate. A similar symptom is typical of granulomas affecting the eyes and parotid lymph nodes.
Inflammation of the lymph nodes - the cervical lymph nodes are especially affected. The increase in size is due to increased lymph outflow and the proliferation of granulomas.
Poor appetite
Constant anxiety and restlessness for no reason
Sleep disturbance
Easily overtired

Clinical picture for stages of sarcoidosis:

The initial, first stage is characterized by the presence of the above-mentioned, general, non-specific signs of sarcoidosis.

In addition, the patient is bothered by pain in the chest area, aching joints, erythema nodosum, and weakness.

Makes you feel sleepy during the day, depression. Stage two, mediastinal, is characterized by an expanded symptomatic pattern:

dyspnea
cough
scattered dry wheezing
chest pain, occasional

The third - pulmonary, is a combination of the first two stages.

The situation is aggravated by increased coughing with sputum, pain increases, and arthralgia occurs.

On at this stage A number of complications are possible:

respiratory failure
emphysema
pneumosclerosis of lung tissue
enlargement and expansion of the right atrium, circulatory failure
liver enlargement
central lesion nervous system
Problems visual organs, Without adequate treatment up to complete loss of vision
wide range of skin pathologies

How is sarcoidosis diagnosed?

List of examinations carried out:

x-ray
high resolution computed tomography
Ultrasound of potentially affected organs: heart, kidneys, thyroid, liver, pelvis
biopsy - material (biopsy) is taken from the affected organ
recording and analysis of the forced expiratory flow-volume curve
electrocardiogram
cytomorphological analysis of biopsy material - material taken during the biopsy procedure, mediastinoscopy, transthoracic puncture

In sarcoidosis, the information content of a study of the liver, nervous system, and heart muscle increases in the case of a magnetic resonance examination. The fact of the lesion is confirmed by scanning with technetium and gallium.

How is pulmonary sarcoidosis treated?

Since the disease has the ability to regress on its own, the patient is dynamically observed by a pulmonologist for six months. This time interval is required to accurately determine the direction vector of specific therapy.

If the patient does not have any breathing problems, is absent, the patient does not suffer from shortness of breath, then immediately therapeutic intervention there is no need for a doctor.

In satisfactory condition, and even minor pathological disorders lung tissue, the patient continues to receive exclusively medical advice from a doctor.

Such therapeutic restraint is due to the ability of granulomas to resolve on their own over time. There is a possibility of recovery without drug therapy.

Severe forms of the disease require adequate therapeutic intervention, since the risk component is high.

Serious complications are possible, including fatal outcome. Indications are: long-term progressive inflammatory process, generalized form of sarcoidosis, when granulomatous lesions have spread to many organs.

Among the medical prescriptions prescribing a long-term (from eight months) course of taking drugs are:

Prednisolone - a specific dosage is prescribed and subsequently adjusted by the doctor. In case of poor tolerability of the drug or side effects, the treatment regimen is changed by prescribing glucocorticoid drugs, taken every two days.
Immunosuppressants
Antioxidants
Anti-inflammatory drugs - Indomethacin, Nimesulide
Potassium preparations

It happens that it is necessary to combine therapeutic regimens: steroid drugs with non-steroidal anti-inflammatory drugs.

The chosen treatment method is influenced by: the nature, degree of progression, severity of the disease.

The flow, diagnosis of the current condition, is monitored by a phthisiatrician. In a favorable scenario, the patient will have to be registered for one and a half to two years, and in case of complications, the disease will “stretch” for up to five years.

Diet

Close attention needs to be paid to a nutritious diet. There is no special profile menu, but it is recommended to adhere to general nutritional recommendations. Consume foods that do not provoke an increase in the inflammatory process.

Salt intake is subject to restrictions, increase the proportion of protein products in the diet. Provide the body with the necessary amount minerals, especially zinc, silicon dioxide, manganese. Diversify your diet with foods that strengthen your immune system:

Limit to a minimum, or better yet exclude: sugar, flour products, cheeses, dairy products. No fried food, only boiled.

Folk remedies

You should not get carried away with treatment at home; such independence can cause a deterioration in the patient’s well-being. secondary measure, permissible only for early stages, after mandatory agreement with a pulmonologist.

Prevention

Since the etiology of the problem remains “vague”, special preventive measures No regarding sarcoidosis, but general recommendations must be followed:

become a supporter of a healthy lifestyle
no smoking
avoid contact with toxic volatile substances, chemicals, dust, dirt - harmful to lung health
good sleep
spend more time outdoors
eliminate calcium-containing foods
you can't sunbathe - action sun rays promotes the production of vitamin D, which retains calcium

The prognosis is moderately favorable; negative symptoms may disappear on their own, without drug support. If the granulomatous “invasion” is limited to the lungs, without extending beyond the chest, then 3/4 of the patients, after five years of conscientious treatment, finally recover.

Advanced, untreated generalized pulmonary sarcoidosis is fraught with serious complications. If the eyes are affected, it is possible total loss vision.

Take an interest in health, goodbye.

Sarcoidosis is a rare systemic diseases with a chronic course. Characteristic manifestation pathology - the formation of granulomas in altered tissues - limited inflammatory foci, which are compacted large nodules. The disease primarily affects the lungs, but the process can affect lymphatic system, liver, spleen, sometimes spreads to bones, skin, eyes and other organs. Treatment of pulmonary sarcoidosis is carried out over a long course hormone therapy, in the absence of measures, respiratory function is impaired.

It is believed that the pathology does not pose an infectious danger. Sarcoidosis predominantly affects people young and middle-aged, for women the statistics are higher by 3–16%. African Americans suffer from the disease 10–17 times more often than the white population of the continent. Among Indians and Eskimos, the disease is diagnosed extremely rarely. In Russia, there are 20 cases per 100 thousand people.

Pathology in different time was described by the scientists Besnier, Beck and Schaumann, therefore sarcoidosis was previously called Besnier-Beck-Schaumann disease, or Beck's disease for short. It is characterized by a multiorgan course, accompanied by stages of exacerbations and remissions. When the disease develops in the lungs, sarcoidosis affects the tissue of the alveoli, causing interstitial inflammation vascular wall(pulmonitis) or alveolitis. Later, epithelioid granulomas form with the presence of blood vessels in the peribronchial and subpleural parts of the organ. Subsequently, the granulomatous formation resolves or transforms into a glassy (hyaline) mass, leading to disruption of the ventilation function of the lungs. Enlarged lymph nodes compress the walls of the bronchi, which causes a deterioration in the air conductivity of the area and the formation of airless zones (atelectasis). What sarcoidosis looks like can be seen in the photo.

Despite multiple studies, the causes of pulmonary sarcoidosis are unknown. Several concepts about the occurrence of the disease have been put forward:

Virologists associate the formation of the inflammatory process with the inhalation of pathogenic microorganisms: viruses and herpes viruses, atypical mycobacteria(Koch bacillus), as well as fungi and mycoplasmas.
Data on familial involvement suggest a genetic theory for the development of the disease.
Other researchers insist on the allergic origin of sarcoidosis, when an immune response occurs to the introduction external stimuli: toxic substances, dust, bacteria. Internal factors of the pathological process include autoimmune reactions.

For the origin of the disease, it is also important professional activity person. Sarcoidosis is most often diagnosed in firefighters, chemical industry workers, postal workers, sailors, and millers or agricultural workers. That is, in people directly associated with toxins or infectious agents.

It is believed that sarcoidosis has a polyetiological nature and its appearance is caused by genetic, morphological and biochemical factors.

Local outbreaks of pathology or cases of infection in a professional environment, when people in contact become ill, indicate that a pathogen is present or the disease is infectious in nature.

Characteristic symptoms of the pathology

With pulmonary sarcodia, symptoms may not appear for a long time. This is associated with weak innervation of the lung tissues, therefore, when granulomas grow, affecting nerve endings doesn't happen for a while. As the process progresses, signs of damage respiratory organs become pronounced. At the beginning of the disease it bothers general symptoms characteristic of the inflammatory process:

weakness;
fatigue;
temperature rise to low-grade levels;
decreased appetite;
subsequently a dry cough develops;
chest pain;
shortness of breath during physical exertion later occurs when walking;
arthralgia – joint pain.

WITH fibrotic changes in the lungs the vital capacity of organs decreases, respiratory and heart failure increases. Diffuse cyanosis develops, increasing with physical exertion, and shortness of breath bothers the patient at rest. It is not uncommon for a patient to develop a symptom drum fingers when the tips of the phalanges thicken.

Upon percussion, a high position of the lower border of the lungs is determined; during inhalation and exhalation, a limitation in the displacement of the organ is noted. In middle and lower parts When listening, moist, crackling rales are detected.

Existing stages of the disease

The classification of pulmonary sarcoidosis is based on data x-ray examination. The stages of the disease are distinguished:

First or initial. Lymphoglandular intrathoracic form, in which bronchopulmonary lymph nodes (lymph nodes) are symmetrically affected on both sides. Sometimes changes are noted in the tracheobronchial lymph nodes; rarely, damage is detected in the paratracheal lymph nodes. There may be disturbances in the lymph structures localized in the second-order branching of the bronchi along the length of the lower trunk of the pulmonary artery on the right side.
The second is mediastinal-pulmonary. The stage is distinguished by damage to the intrathoracic lymph nodes (IHL). The process spreads to the middle and lower parts of the organ, and lung tissue is affected in a small-focal and reticular manner.
The pulmonary form occurs in stage 3 of the disease. Changes in organ tissue are pronounced; there is no increase in VGLU. Dense dissemination is observed in the middle sections; lung tissue is replaced by connective tissue (pneumosclerosis). There is also accumulation of air in the distal space of the terminal bronchioles due to destructive changes affecting the alveolar walls (emphysema).

According to its manifestations, the disease is divided into periods: the active phase is exacerbation of sarcoidosis, the next phase is stabilization and the stage of regression, attenuation. Reverse process in some cases, it is characterized by the resorption of granulomas or their calcification. According to the rate of development of changes in the lungs, sarcoidosis is divided into:

to progressive;
to slow;
to abortive, that is, stopping the flow;
to chronic.

After treatment or resorption of granulomas, the consequences of the illness may include pneumosclerosis, pleurisy, emphysema, tissue fibrosis at the roots of the lungs with or without calcification of the upper lymph nodes.

Diagnosis and treatment

To confirm sarcoidosis of the respiratory system, a set of measures is carried out to identify pathology and differentiate signs from other diseases with similar symptoms: tuberculosis, lymphogranulomatosis, fibrosing alveolitis. What methods are used:

X-ray examination of the lungs reveals changes in the organs. The images show a decrease in the transparency of the lung tissue and lymphadenopathy; areas may be mirror-like or with pronounced asymmetry. In later stages they are found focal changes, fibrosis, emphysema or tissue cirrhosis.
If radiography is insufficiently informative, an MRI or CT scan of the lungs is prescribed.
Bronchoscopy shows dilation of blood vessels in the lower parts of the bronchi, sarcoidous changes in their mucosa, characterized by plaques or warty growths. Signs of atrophic bronchitis and lymph node enlargement are noted at the bifurcation site.
Transbronchial biopsy or mediastinoscopy allows you to obtain part of the biopsy for research, eliminating erroneous diagnosis by 80–95%. Segments of epithelioid granuloma without manifestations of necrotization of the perifocal inflammatory process are found in the tissues.
A blood test in the acute form indicates an increase in angiotensin converting enzyme, as well as an increase in ESR, leukocytes, eosinophils, monocytes and lymphocytes.

The Kveim reaction manifests itself as a positive result in the form of redness to the injection of sarcoid antigen under the skin. This method of research is rarely carried out due to the complexity and danger of introducing infection.

Drugs

Identified sarcoidosis of the respiratory system in most cases is accompanied by remission, so the development of the disease is first monitored for six months or 8 months. It is necessary to treat the pathology when the disease progresses, acquires acute course, intrathoracic lymph nodes are affected, dissemination is observed in the lung tissues. Therapy is also indicated for complex and generalized manifestations of the disease. Sarcoidosis is treated:

Steroid hormones, course duration is at least 3–6 months. The corticosteroid Prednisolone is used or similar drugs, improvement occurs in 80% of cases. The treatment regimen involves daily administration of the drug at a dose of 0.5–1 mg/kg for 3 months. Then the dosage is reduced to 10–15 mg, the course of maintenance treatment lasts for 6 months or a year.
When adverse reactions occur, they worsen concomitant diseases, hormones are prescribed in a course with breaks of 1–2 days.
If insensitivity to steroids is detected, alternative drugs against cancer tumors are used - Methotrexate, Cyclophosphamide.
Possible complex therapy for 4–6 months: Prednisolone or Dexamethasone alternate with the use of non-steroidal anti-inflammatory drugs - Diclofenac or Indomethacin.
In the initial stages of the disease, the use of corticosteroids (Fluticasone) in the form of inhalations is allowed.

At the same time they prescribe antioxidant drugs and vitamins C, D, E, immunosuppressants and physical therapy.

Folk remedies

At an early stage of pathology development, the use folk remedies for the treatment of pulmonary sarcoidosis promotes remission of the disease. What recipes are suitable:

Propolis (20 g) is crushed and infused in 125 ml of vodka in a dark glass container. Take 60 minutes before meals three times a day, 15 or 20 drops, diluted in half a glass of water.
Vodka mixed with unrefined sunflower oil 1:1, take a tablespoon three times a day before meals. The course of treatment is 10 days, then a five-day break. This is repeated 3 times.
Tincture of ginseng or rose radiole is drunk in the morning and evening, 20–25 drops, the duration of the course is at least 15–20 days.
To relieve inflammation and absorb granules, use thyme infused with honey. Fresh beekeeping product (250 ml) is mixed with the plant, if necessary, water (50 ml) is added. The composition is infused for 15 days in the dark. Strain the infusion and drink a spoonful morning and evening.

Antioxidants, saponins, flavonoids, which are contained in birch sap, also help treat the disease. The juice is drunk in combination with milk (1:1) half a glass daily.

Cannot be used to treat cough badger fat: This popular remedy worsens the condition of the patient with sarcoidosis.

With sarcoidosis, a properly selected diet is of no small importance. It is especially important to follow a diet during hormone therapy: this helps to avoid complications in the future. The diet should be organized correctly:

Since sarcoidosis is accompanied by an inflammatory process, it is necessary to reduce carbohydrate intake, since organic substances contribute to its development. Reduce the amount of sugar, sweets, flour products, exclude carbonated drinks.
It is prohibited to include smoked meats, pickles, and spices in your diet. If it is difficult to do without spicy foods, you are allowed to eat garlic or raw onions.
With sarcoidosis, the calcium content in the blood increases, and there is a risk of stone formation in the urinary tract. Therefore, the consumption of dairy products is reduced to a minimum. The use of butter is allowed to a limited extent.
Alcohol in any quantity or dosage is not allowed.

It is recommended to eat more fruits, berries and raw vegetables: antioxidants, vitamins and valuable elements in their composition help fight the disease. Potassium intake is especially important (bananas, potatoes, dried fruits, nuts). It is necessary to include proteins in the diet: meat low-fat varieties, fish dishes, eggs. The supply of protein of non-animal origin is provided by legumes and vegetable oils. The consumption of low-fat milk and cottage cheese is allowed to a limited extent.

Prognosis for pulmonary sarcoidosis

In pulmonary sarcodiasis, the disease is characterized by a predominantly benign course. The prognosis is favorable for patients in whom the pathology has not acquired a widespread form. What the statistics say:

60% of patients are asymptomatic;
in 30% of patients the exacerbation ends in spontaneous remission;
with changes only in the lung tissue or lymph nodes, after 5 years 75% of people recover;
relapses of the disease occur in half of the cases;
in Europe, recovery is observed in almost 90% of patients.

A chronic form of the disease with fibrotic changes in tissues is observed in a third of patients, sometimes manifesting obvious respiratory failure. Extensive damage to the lungs with impaired alveolar ventilation leads to myocardial pathology, spread of the disease to other organs, deposition of calcareous growths in the kidneys, inflammation of the choroid (uveitis) and hypercalcemia. Eye lesions can result in loss of vision. Rarely (5%) with generalized changes, lack of treatment leads to the death of the patient.

The disease develops unpredictably; it is noted that the prognosis for patients with dark skin less favorable. Spontaneous manifestation acute form often indicates a rapid recovery. The appearance of shortness of breath and skin lesions indicate the likelihood of a prolonged course of the disease.

In order to prevent exacerbations of the disease, it is important to avoid bad habits, lead a correct lifestyle. It is necessary to eliminate exposure to chemicals and toxins, gases and dust that negatively affect the body. respiratory system. To prevent the formation of kidney stones, you should organize a balanced diet.